Category: Clinical Stones: Medical Management

MP31-8 - Coconut Water: An Unexpected Source of Urinary Citrate

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Coconut water has long been touted for its medicinal qualities including natural hydration. We sought to determine whether its consumption would favorably alter urinary lithogenic factors.

Methods : Volunteers with no prior history of nephrolithiasis were recruited. Each participant served as their own control; participants were randomized initially to receive 2 liters/day of coconut water (Taste of Nirvana®) or tap water for 4 days after which they had a 2 week washout period and then received the 4 day fluid trial they did not have in the first phase (i.e. tap water or coconut water). Participants kept meticulous food and fluid intake logs during the first phase of the study and were asked to replicate that diet for the second phase. Participants were not restricted to consume additional fluid of their choice during their assigned study phase.  During days 3 and 4 of each phase the participant collected a 24-hour urine specimen. Coconut water, citrate, and malate content were measured and were used along with the beverage pH to calculate the total alkali content of the coconut water. Supersaturation levels were calculated using Equil2.

Results : There were 4 adult male and 4 adult female participants; none had a history of urolithiasis. Each individual 24-hour urine collection had a creatinine excretion within 20% of the mean for each subject’s four samples corroborating that all samples were collected properly. The two samples from each phase for each individual were averaged. Analysis of the coconut water revealed an alkali content of 13.8 mEq/L (Table 1). During the coconut water phase, urinary citrate rose 29% (p=0.02), urinary potassium rose 130% (p=0.01), and urinary chloride increased 37% (p=0.03); there was no affect on urine pH (p=0.16) or volume (p=1.00) (Table 2). Statistical significance for urinary citrate, potassium and chloride was maintained when adjusting for both gender and age.

Conclusions : Coconut water consumption increases urinary potassium, chloride, and citrate in non-stone forming male and female adults.

Roshan M. Patel

Assistant Clinical Professor
University of California, Irvine, Department of Urology
Orange, California

Pengbo Jiang

Orange, California

John Asplin

Medical Director
Litholink Corporation
Chicago, Illinois

Ignacio Granja

Chicago, Illinois

Kathryn Osann

Orange, California

Zhamshid Okhunov

University of California, Irvine, Department of Urology
Orange, California

Jaime Landman

Professor and Chair
Department of Urology, University of California, Irvine, Orange, CA
Orange, California

Professor Landman completed his medical training at Columbia University. He then completed his Urology residency at Mt. Sinai Hospital in New York before moving to St. Louis to complete his minimally invasive urology training at Washington University under the guidance of Dr. Ralph Clayman. Dr. Landman’s fellowship training focused on the minimally invasive treatment of renal diseases.

Prof. Landman focuses on developing new clinical approaches to minimally invasive and more effective treatments for surgical renal diseases such as renal cell carcinoma, urolithiasis and ureteropelvic junction obstruction. For the past decade, his clinical practice has been focused almost exclusively on the minimally invasive management of kidney disease with a focus on renal oncology and urolithiasis.

Since 2002 Dr. Landman has directed an active minimally invasive urology laboratory. His laboratory has focused largely on innovative minimally invasive solutions in the diagnosis and treatment of urologic malignancies, kidney stones and the development of minimally invasive surgical technologies.

A major focus of Dr. Landman’s efforts has been the didactic and technical training of students, residents and fellows. Dr. Landman has had an active role in medical student and resident education since 2001. Since 2002 Dr. Landman has been actively directing the Endourology sanctioned clinical and research fellowship, and he was until recently the program director for the UC Irvine Urology residency. Dr. Landman engendered and currently directs the LIFT (Leadership Innovation Fellowship Training) program at UC Irvine and has focused on helping medical students become academic leaders in Urology.

A current focus of Dr. Landman’s research remains didactic and technical training for students, residents and fellows. His research team continues to develop novel strategies for surgical education.

Ralph V. Clayman

University of California, Irvine, Department of Urology
Orange, California